Signs and symptoms: 5-month history of painful lesions on the left lower leg. Prior to appearance of lesions, patient had noted numbness and burning of left lower extremity. Patient denied systemic symptoms. No relevant prior medical history or family history.

Previous Treatment: None

Other information:

PHYSICAL EXAM:

Four ill-defined, coalescing 1-cm violacious plaques with surrounding erythema on the left anterior tibia

LABORATORY TESTS:

DERMATOHISTOPATHOLOGY:

Low power demonstrates diffuse inflammatory infiltrate of the dermis and subcutis with a Grenz zone. On higher power, large round immunoblasts are appreciated. Staining for Bcl-2 and MUM-1 is diffusely positive